LUMBAR SPONDYLOSIS PHYSIOTHERAPY MANAGEMEN

1. Lumbar
Spondylosis

2. CONTENT…
• Anatomy of the vertebral column
• Anatomy of the vertebrae
• What is spondylosis?
• Causes and Risk Factors
• Signs and symptoms
• Diagnosis
• Special tests
• Management
• Advices to the patient

3. Anatomy of the vertebral column…

4. Anatomy of the vertebrae…

6. What is spondylosis?
• Spondylosis refers to degenerative
changes in the spine such as bone
spurs and degenerating intervertebral
discs
• Spondylosis changes in the spine are
frequently referred to as osteoarthritis

7. • Spondylosis (spine arthritis) is one of
the most common causes of spine pain
and stiffness once you are aged over
fifty
• Spondylosis is further categorised
depending on the region of the spine
that it is present
– Cervical Spondylosis (Neck Arthritis)
– Thoracic Spondylosis (Mid Back Arthritis)
– Lumbar Spondylosis (Low Back Arthritis)

9. Causes and Risk Factors…
• Spondylosis is an aging phenomenon
• With age, the bones and ligaments in the
spine wear, leading to bone spurs
(osteoarthritis)
• Also, the intervertebral discs degenerate and
weaken, which can lead to disc herniation and
bulging discs

10. • Spondylosis is common
• Symptoms are often first reported
between the ages of 20 and 50
• Over 80% of people over the age of
40 have evidence of spondylosis on X-
ray studies
• The rate at which spondylosis occurs
is partly related to genetic
predisposition as well as injury history

11. Signs and symptoms…
• Many people do not have any symptoms(27%-
37%)
• Spinal stiffness, particularly early morning
• Back pain due to nerve compression
• Regional tenderness
• Muscle spasm
• Trigger points
• Sciatica
• Numbness
• Weakness

12. Diagnosis…
• X-rays
• MRI
• CT scans

16. Special tests
Sacroiliac joint stress test
• Patient position – Supine
• The therapist crosses their arms placing the
palms of the hands on the patient’s ASIS
• The therapist applies a downward and a
lateral force to the pelvis
• Positive test – Indicated by unilateral pain in
the sacroiliac joint or gluteal region and may
be indicative of Sacroiliac joint dysfunction

17. Sitting flexion test
• Patient position – Sitting with the
knees flexed to 90 degrees and feet on
the floor
• The patient’s hip should be abducted to
allow the patient bend forward
• The therapist place his/her thumb on
the inferior margin of the PSIS’s and
monitors the movement of the bony
structures as the patient bends forward
and reaches towards the floor

18. • Positive test
– Indicated
by one PSIS
moving
further in a
cranial
direction
and may be
indicative of
an articular
restriction

19. Standing flexion test
• Patient position – standing with the
feet 12 inches apart
• The therapist places his/her thumbs on
the inferior margin of the PSIS’s and
monitors the movement of the bony
structures as the patient bends
forward with the knees extended
• Positive test – Indicated by one PSIS
moving further in a cranial direction
and may be indicative of an articular
restriction

21. Straight leg raising test
• Patient position – Supine
• The therapist lifts the patient's
symptomatic leg by the posterior ankle
while keeping the knee in a fully
extended position
• The therapist continues to lift the
patient's leg by flexing at the hip until
pain is illicited or end range is reached

22. • Neurologic pain which is reproduced
in the leg and low back between 30-70
degrees of hip flexion is a positive
result of lumbar disc herniation at the
L4-S1 nerve roots
• In order to make this test more
specific, the ankle can be dorsiflexed
and the cervical spine flexed
• This increases the stretching of the
nerve root and dura

23. • Pain at less than 30 degrees of hip
flexion might indicate acute
spondyloithesis, gluteal abscess, disc
protrusion or extrusion, tumor of the
buttock, an acute dural inflammation,
a malingering patient, or the sign of
the buttock
• Pain at greater than 70 degrees of hip
flexion might indicate tightness of the
hamstrings, gluteus maximus, hip
capsule or a pathology of the hip or
sacroiliac joints

24. • A highly
specific test
that can aid
in the
diagnosis of
a herniated
nucleus
pulposus is
the crossed
straight leg
raise test

25. Management…
Management
Medical Physiotherapy

26. Medical management
• No medication has been proven to reverse the
degenerative process of spondylosis
• Anti-inflammatory medications (NSAID’s)
• Analgesics
• Muscle relaxants

27. • Surgery is rarely necessary in patients
with acute back pain, unless
progressive neurologic problems
develop
• This is because most patients improve
dramatically after treatment with
medications and physical therapy, and
most patients improve within days to
weeks after back pain starts

28. • Surgery is sometimes performed for
acute sciatica, if nerve problems such
as weakness and numbness are
severe and worsen rather than
improve, and cauda equina syndrome,
a syndrome where the nerves at the
bottom of the spinal cord are
compressed by an intervertebral disc
or a mass, causing neurologic
problems

29. Physiotherapy management
• In many cases of lumbar spondylosis, rest
coupled with physical therapy is ordered
• And in 75 percent of the cases, physical
therapy and rest take care of the problem
• Physical therapy can ease back stiffness
• Exercises such as crunches and abdominal
workouts can strengthen and rehabilitate
muscles and joints near the spine and
stomach, helping ease pressure and pain on
the spine

30. • Physical therapists also use electronic
stimulation and heat to reduce pain
and muscle spasms linked to
spondylosis
• Exercises involving pulleys and
weights are often used to strengthen
a patient's neck and back muscles
• A physical therapist can also provide
strategies to limit the risk of future
back problems and whether any
restrictions in work or recreational
activities are required

31. • Possible physical therapy exercises
include yoga-like exercises and other
exercises to increase flexibility and
strength
• Stretching exercises are also common
forms of treatment

32. Exercises for spondylosis
• Back exercise 1
– Lie on your back on the floor, bend your
left knee, and put your left foot on the
floor
– Tighten your buttock and abdominal
muscles
– Maintain your neutral position
– Raise your right leg off the floor 12
inches, keeping your knee straight
– Hold this position and count to three
– Lower your leg

33. ‒ Repeat 10 times
‒ Do the exercise 10 times with your left
leg raised
‒ Vary the exercise by making squares and
circles with the raised leg

34. • Back exercise 2
– Get into a kneeling position on the floor
– Tighten your buttock and abdominal
muscles
– Stay in your neutral position
– Put your hands on your hips
– Raise your right foot off the floor, and
place it down in front of you
– You should now be kneeling on your left
knee
– Lunge forward, moving from your hips

35. – Hold this position and count to three
– Go back to your original kneeling position
– Repeat the exercise 10 times with your
right leg
– Then do the exercise 10 times on the
other side

36. • Single-leg lift
– It is important to stretch your lower back
and keep your spine in alignment
– You can do this by doing single-leg lifts
– Lie face-down on the floor
– Place your two hands under your chin
and lift your head up slightly so that it is
in line with your spine
– Slowly lift your left leg up about 6 to 8
inches and hold it for three seconds

37. – Do not flex or point your foot
– Put your leg down in the starting
position
– Now lift your right leg up for three
seconds to a similar height
– Do this 10 times with each leg to gently
stretch your lower back

38. • Arm curls on exercise ball
– Sit on a medium-sized exercise ball, 12 to
16 inches in diameter, and find your
balance point
– Grasp hold of two 4-lb
– weights and let your arms extend down
to your sides
– Alternately curl the weights up to
shoulder height, holding the weight at
the top of the lift for two seconds
– Do 10 lifts with each arm, take a 30-
second break and repeat the set

39. – The weights are light enough so that you
should not strain any muscles, but the
action of doing the curls on the exercise
ball will be beneficial for your lumbar
area

40. • Pelvic Tilt
– The pelvic tilt exercise helps ease the
compressive forces in your lower back by
stretching your lower spine
– Begin by lying down on your back with
both knees bent and the soles of your
feet flat on the floor
– Use the muscles of your abdomen to
push your lower back down until it is in
contact with the floor
– Hold this position for five to 10 seconds,
then relax
– Repeat 10 times

42. • Double Knee to Chest
– Like the pelvic tilt exercise, this exercise
improves the range of motion in your
lower back by decompressing your spine
– Begin by lying down on your back with
both legs extended and your arms by
your sides
– Bend both knees at the same time and lift
your feet off the floor
– Reach up with both arms and grab your
legs around the shins

43. – Use the muscles of your arms to pull
both knees toward your chest
– Hold this stretch for five to 10 seconds
– Perform three sets of five to 10
repetitions daily

44. • Pelvic Bridge
– This exercise helps strengthen the
muscles of your lower back
– Begin by lying down on your back with
your knees bent and the soles of your
feet flat on the floor
– Cross both of your arms across your
chest while simultaneously tightening the
muscles of your abdomen
– Use a slow and controlled motion to lift
your hips off the floor until there is a
straight line between your knees, hips
and shoulders

45. – Hold this position for five to seven
seconds, then return to the starting
position using a slow and controlled
motion
– Repeat 10 times a day

47. Advices to the patient…
• Avoid long term sitting and standing
• Avoid high heels
• Reduction of weight (if the patient is obese)
• Do not use a very soft or a spring metress
• Use correct postures